It has been proposed that the imaging workup of trauma patients be accelerated by omitting the initial chest radiography (CR) and directly performing a computed tomography (CT); however, the baseline CR is then lacking. The purpose of this study was to assess if coronal thick reconstructions generated from chest CT could present an adequate alternative for CR. Sixty trauma patients underwent bedside CR and multidetector row chest CT in the emergency room. The image quality of thoracic anatomical structures, the diagnostic accuracy for chest pathology, and the depiction of indwelling devices were assessed on both modalities. Main pulmonary arteries and perihilar bronchi were equally visualized with both modalities. Central bronchi, retrocardial lung parenchyma, diaphragm, descending aorta, and vertebral pedicles were better visualized on thick CT reconstructions, whereas peripheral lung vessels were better depicted on CR (p<0.05). The accuracy to delineate various pathological findings did not differ between both modalities, except for a higher sensitivity to diagnose bronchial cuffing on CR (p<0.05). The location of indwelling devices was similarly and correctly depicted with both modalities. Coronal thick CT reconstructions provide a similar image quality and diagnostic accuracy compared with CR. These reconstructions may serve as an equivalent baseline image in trauma patients in whom emergency radiological evaluation has to be accelerated.
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Bell RM, Krantz BE, Weigelt JA (1999) ATLS: a foundation for trauma training. Ann Emerg Med 34:233–237
Olson CJ, Arthur M, Mullins RJ, Rowland D, Hedges JR, Mann NC (2001) Influence of trauma system implementation on process of care delivered to seriously injured patients in rural trauma centers. Surgery 130:273–279
American College of Surgeons Committee on Trauma (1997) Student course manual. Advanced trauma life support for doctors. American College of Surgeons, Chicago
Schweiberer L, Nast-Kolb D, Duswald KH, Waydhas C, Muller K (1987) Polytrauma-treatment by the staged diagnostic and therapeutic plan. Unfallchirurg 90:529–538
Massarutti D, Berlot G, Saltarini M, Trillo G, D'Orlando L, Pessina F, Modesto A, Meduri S, Da Ronch T, Carchietti E (2004) Abdominal ultrasonography and chest radiography are of limited value in the emergency room diagnostic work-up of severe trauma patients with hypotension on the scene of accident. Radiol Med (Torino) 108:218–224
Collins JA, Samra GS (1998) Failure of chest X-rays to diagnose pneumothoraces after blunt trauma. Anaesthesia 53:74–78
Neff MA, Monk JS Jr., Peters K, Nikhilesh A (2000) Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. J Trauma 49:281–285
Leidner B, Adiels M, Aspelin P, Gullstrand P, Wallen S (1998) Standardized CT examination of the multitraumatized patient. Eur Radiol 8:1630–1638
Low R, Duber C, Schweden F, Lehmann L, Blum J, Thelen M (1997) Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations. Rofo 166:382–388
Boehm T, Alkadhi H, Schertler T, Baumert B, Roos J, Marincek B, Wildermuth S (2004) Application of multislice spiral CT (MSCT) in multiple injured patients and its effect on diagnostic and therapeutic algorithms. Rofo 176:1734–1742
Diederich S, Lenzen H (2000) Radiation exposure associated with imaging of the chest: comparison of different radiographic and computed tomography techniques. Cancer 89:2457–2460
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Novelline RA, Rhea JT, Rao PM, Stuk JL (1999) Helical CT in emergency radiology. Radiology 213:321–339
Linsenmaier U, Krotz M, Hauser H, Rock C, Rieger J, Bohndorf K, Pfeifer KJ, Reiser M (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740
Voggenreiter G, Aufmkolk M, Majetschak M, Assenmacher S, Waydhas C, Obertacke U, Nast-Kolb D (2000) Efficiency of chest computed tomography in critically ill patients with multiple traumas. Crit Care Med 28:1033–1039
Alkadhi H, Wildermuth S, Desbiolles L, Schertler T, Crook D, Marincek B, Boehm T (2004) Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. Radiographics 24:1239–1255
This research has been supported by the National Center of Competence and Research, Computer Aided, and Image Guided Medical Interventions (NCCR CO-ME) of the Swiss National Science Foundation.
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Alkadhi, H., Baumert, B., Wildermuth, S. et al. Coronal thick CT reconstruction: an alternative for initial chest radiography in trauma patients. Emerg Radiol 12, 3–10 (2005). https://doi.org/10.1007/s10140-005-0432-1